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Clinical features and outcome of acquired myasthenia gravis in 94 dogs

BACKGROUND: Factors known to be associated with outcome of acquired myasthenia gravis (MG) in dogs are limited. HYPOTHESIS/OBJECTIVES: Of dogs with MG, advancing age and comorbid neoplasia are associated with poor long‐term prognosis and low rates of remission. ANIMALS: Ninety‐four client‐owned dogs...

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Autores principales: Forgash, Jennifer T., Chang, Yu‐Mei, Mittelman, Neil S., Petesch, Scott, Benedicenti, Leontine, Galban, Evelyn, Hammond, James J., Glass, Eric N., Barker, Jessica R., Shelton, G. Diane, Luo, Jie, Garden, Oliver A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478050/
https://www.ncbi.nlm.nih.gov/pubmed/34331481
http://dx.doi.org/10.1111/jvim.16223
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author Forgash, Jennifer T.
Chang, Yu‐Mei
Mittelman, Neil S.
Petesch, Scott
Benedicenti, Leontine
Galban, Evelyn
Hammond, James J.
Glass, Eric N.
Barker, Jessica R.
Shelton, G. Diane
Luo, Jie
Garden, Oliver A.
author_facet Forgash, Jennifer T.
Chang, Yu‐Mei
Mittelman, Neil S.
Petesch, Scott
Benedicenti, Leontine
Galban, Evelyn
Hammond, James J.
Glass, Eric N.
Barker, Jessica R.
Shelton, G. Diane
Luo, Jie
Garden, Oliver A.
author_sort Forgash, Jennifer T.
collection PubMed
description BACKGROUND: Factors known to be associated with outcome of acquired myasthenia gravis (MG) in dogs are limited. HYPOTHESIS/OBJECTIVES: Of dogs with MG, advancing age and comorbid neoplasia are associated with poor long‐term prognosis and low rates of remission. ANIMALS: Ninety‐four client‐owned dogs with MG diagnosed by acetylcholine receptor antibody (AChR Ab) assay between 2001 and 2019 from a university clinic and 3 private clinics in the United States. METHODS: Cases were retrospectively evaluated and data were collected to determine clinical signs, treatment, and response to therapy defined by means of a clinical scoring rubric. Immunological remission was defined as a return of the AChR Ab concentration to <0.6 nmol/L. Multivariable binary logistic regression analysis was used to identify clinical criteria predicting remission. RESULTS: An anticholinesterase drug was used to treat 90/94 (96%) dogs, which in 63/94 (67%) was the sole treatment; other drugs included immune modulators. Clinical remission (lack of clinical signs ≥4 weeks after treatment cessation) was observed in 29 (31% [95% confidence interval (CI): 22.4‐40.8%]) dogs, clinical response (lack of clinical signs on treatment) in 14 (15% [95% CI: 9.0‐23.6%]) dogs, clinical improvement (on treatment) in 24 (26% [95% CI: 17.8‐35.2%]) dogs, and no clinical improvement in 27 (29% [95% CI: 20.5‐38.6%]) dogs. Immunological remission was observed in 27/46 (59%) dogs, with clinical remission in all 27. Younger age (P = .04) and comorbid endocrine disease (P = .04) were associated with clinical remission. Initial AChR Ab concentration (P = .02) and regurgitation (P = .04) were negatively associated with clinical remission. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinical remission in MG is less likely in older dogs and dogs presenting with regurgitation or high initial AChR Ab concentration, but more likely in younger dogs and dogs with comorbid endocrine disease.
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spelling pubmed-84780502021-10-01 Clinical features and outcome of acquired myasthenia gravis in 94 dogs Forgash, Jennifer T. Chang, Yu‐Mei Mittelman, Neil S. Petesch, Scott Benedicenti, Leontine Galban, Evelyn Hammond, James J. Glass, Eric N. Barker, Jessica R. Shelton, G. Diane Luo, Jie Garden, Oliver A. J Vet Intern Med SMALL ANIMAL BACKGROUND: Factors known to be associated with outcome of acquired myasthenia gravis (MG) in dogs are limited. HYPOTHESIS/OBJECTIVES: Of dogs with MG, advancing age and comorbid neoplasia are associated with poor long‐term prognosis and low rates of remission. ANIMALS: Ninety‐four client‐owned dogs with MG diagnosed by acetylcholine receptor antibody (AChR Ab) assay between 2001 and 2019 from a university clinic and 3 private clinics in the United States. METHODS: Cases were retrospectively evaluated and data were collected to determine clinical signs, treatment, and response to therapy defined by means of a clinical scoring rubric. Immunological remission was defined as a return of the AChR Ab concentration to <0.6 nmol/L. Multivariable binary logistic regression analysis was used to identify clinical criteria predicting remission. RESULTS: An anticholinesterase drug was used to treat 90/94 (96%) dogs, which in 63/94 (67%) was the sole treatment; other drugs included immune modulators. Clinical remission (lack of clinical signs ≥4 weeks after treatment cessation) was observed in 29 (31% [95% confidence interval (CI): 22.4‐40.8%]) dogs, clinical response (lack of clinical signs on treatment) in 14 (15% [95% CI: 9.0‐23.6%]) dogs, clinical improvement (on treatment) in 24 (26% [95% CI: 17.8‐35.2%]) dogs, and no clinical improvement in 27 (29% [95% CI: 20.5‐38.6%]) dogs. Immunological remission was observed in 27/46 (59%) dogs, with clinical remission in all 27. Younger age (P = .04) and comorbid endocrine disease (P = .04) were associated with clinical remission. Initial AChR Ab concentration (P = .02) and regurgitation (P = .04) were negatively associated with clinical remission. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinical remission in MG is less likely in older dogs and dogs presenting with regurgitation or high initial AChR Ab concentration, but more likely in younger dogs and dogs with comorbid endocrine disease. John Wiley & Sons, Inc. 2021-07-31 2021 /pmc/articles/PMC8478050/ /pubmed/34331481 http://dx.doi.org/10.1111/jvim.16223 Text en © 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle SMALL ANIMAL
Forgash, Jennifer T.
Chang, Yu‐Mei
Mittelman, Neil S.
Petesch, Scott
Benedicenti, Leontine
Galban, Evelyn
Hammond, James J.
Glass, Eric N.
Barker, Jessica R.
Shelton, G. Diane
Luo, Jie
Garden, Oliver A.
Clinical features and outcome of acquired myasthenia gravis in 94 dogs
title Clinical features and outcome of acquired myasthenia gravis in 94 dogs
title_full Clinical features and outcome of acquired myasthenia gravis in 94 dogs
title_fullStr Clinical features and outcome of acquired myasthenia gravis in 94 dogs
title_full_unstemmed Clinical features and outcome of acquired myasthenia gravis in 94 dogs
title_short Clinical features and outcome of acquired myasthenia gravis in 94 dogs
title_sort clinical features and outcome of acquired myasthenia gravis in 94 dogs
topic SMALL ANIMAL
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478050/
https://www.ncbi.nlm.nih.gov/pubmed/34331481
http://dx.doi.org/10.1111/jvim.16223
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